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WEEK 26:
LEG PAIN PLENARY:
| Question | Answer |
|---|---|
| cellulitis (skin infection) features | red and hot to touch |
| Eron classification | system used to assess severity of cellulitis and guide treatment decisions |
| how many classes in eron classification | 4 |
| class 1 eron classification | no systemic toxicity use oral antibiotics |
| class 2 eron classification | systemically unwell (temperature, comorbidity that will slow healing) and consider out-patient IV/IM antibiotics |
| class 3 eron classification | significant systemic upset (systemically unwell) to consider admission of has unstable comorbidities or limb threatening infection and immediate admission |
| class 4 eron classification | red flag sepsis or life threatening infection (eg necrotizing fasciitis) and immediate admission |
| erythema meaning | redness of skin caused by increased blood flow (vasodilation) |
| signs of DVT | usually unilateral asymmetric skin warmth calf or ankle swelling asymmetrical calf swelling of >2cm swelling of entire leg red or discoloured skin on leg superficial venous dilation |
| difference between cellulitis and DVT | swelling more apparent in DVT |
| risk factors for DVT | immobility (surgery post op/ long haul flight) oestrogen therapy (HRT, combined contraceptive pill, pregnancy) hypercoagulable state (smoking, malignancy/ chemotherapy, thrombophilia, antithrombin deficiency, and dehydration) |
| Well's assessment score of 3 or more means | is likely to be DVT |
| when should you refer same day assessment and management | if DVT suspected in woman who is pregnant or has given birth within the past 6 weeks |
| how do vessels appear in ultrasound | black (as full of fluid) |
| colour doppler imaging | enables assessment of flow velocity and direction within vessel- absence of colour means there is lack of flow and could suggest occlusion |
| DOAC | direct oral anticoagulant - block specific clotting factors eg factor Xa inhibitors (rivaroxaban) |
| treatment options | LMWH (clexane) for duration of therapy DOAC (rivaroxaban) for duration of therapy VKA (Warfarin) and continue LMWH in short term until INR is within therapeutic range |
| positives of DOAC treatment | oral (not SC) simple dosing regime no need for ongoing monitoring with blood tests better side effect profile |
| how long do we anti-coagulate for DVT if only once | 3 months |
| how long do we anti-coagulate for DVT if recurrent DVT/ PE | lifelong |
| complications of DVT | PE MI stroke post thrombotic syndrome (leg pain, proximal swelling, skin change, ulceration frequently recurring and impairs mobility and quality of life) treatment complications |
Created by:
kablooey
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